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The Rising Rate of Suicide in the United States: Why?

Every morning, when I wash my breakfast dishes, I glance at a photograph of a close friend who committed suicide 15 years ago. I placed his photo next to one of the Dalai Lama, a person he admired. Seeing their two photos’ together, as the morning sun streams into the kitchen, gives me comfort. I miss my friend Andy.

Sadly, suicide rates among middle-aged Americans have risen sharply in the last decade. The Centers for Disease Control (CDC) reports that there are more people who die yearly of suicide than in car accidents. In 2010, there were 33,687 deaths from motor vehicle crashes and 38,364 suicides. And these only account for the suicides that were reported.

The high rate of suicide in the military has also been extremely troubling. Last year more active duty soldiers killed themselves than died in combat. The rate of men and women in the armed forces that have committed suicide has been growing since 2004.

Despite all of the technological changes in this 21st century, new medications, treatments, and improved assessment techniques, the suicide rate in the United States has held relatively steady since 1942. Roughly one million people kill themselves every year in the world.

In a recent article in the New York Times (The Suicide Detective, June 26, 2013), the author describes the hunt for better ways of predicting suicide in potentially vulnerable individuals.

What we do know, is that suicide rates are higher in individuals with psychiatric conditions such as mood disorders, social isolated individuals, substance abusers, elderly white males, young American Indians, adults who have suffered abuse as children, and those individuals with ready access to guns. Thomas Frieden, the director of the CDC, appeared on television in response the announcement of the increased rate of suicide and suggested that viewers develop a social life, get help for mental health problems, exercise, and drink alcohol in moderation. In other words, try to stay out of the group of individuals with a high suicide rate.

Why is it so hard to predict suicide, even in the groups with higher rates? The author of the Times article, Kim Tingley notes “Our understanding of how suicidal thinking progresses, or how to spot and halt it, is little better now that it was two and half centuries ago, when we first began to consider suicide a medical rather than philosophical problem, and physicians prescribed, to ward it off, buckets of cold water thrown at the head”.

In 2003, a group of researchers at Harvard evaluated a group of 157 patients who had recently made a suicide attempt in order to evaluate how likely they would make another attempt. In a six-month follow-up, clinicians were no better than 50-50 in predicting who would make another attempt.

Matthew Nock, the Director of Harvard University’s laboratory for Clinical and Developmental Research notes that while there are many theories as to why suicide has increased among middle-aged men, data is hard to come by. Public health officials speculate that the rise in suicide among middle-aged men is connected to challenges from our troubled economy, the stress of caring for elderly parents and children, and increased access to prescription drugs that can be deadly in high doses.

In 1897, the noted French sociologist, Emile Durkheim, suggested the first comprehensive theory of suicide. He saw suicide as a response to an individual’s relationship with society—lost of community and disconnection from the fabric of daily life were possible triggers. More recent psychological theories focus on mental pain, hopelessness, despair, and a feeling of being a burden to others.

What is so frustrating, for mental health providers and families alike, is that unless a person has a history of suicidal gestures (past history is the best predictor of the future) and expresses suicidal thoughts and intent (“I think about killing myself, and I want to do it”), it is extremely difficult to know what is in someone’s mind. The sad truth is that many individuals who do commit suicide do not share these feelings in the hours or days before taking their life.

In Part II of this post (coming on Wednesday), I will describe some of the warning signals and the impact of suicide on family and friends.

Comments

Submitted by Dr. Paul Fan on Mon, 07/01/2013 - 12:42pm

I've had two suicides in my life, a husband and a nephew. The first was a case of mental illness who was not receiving good medical care and spiraled out of control. The other was just a sad situation where a young man couldn't see his way out. When my nephew took his life the entire family was devastated. I see how it's shaped his siblings lives and how deeply it's impacted his parents. And my views on suicide too. It's the saddest thing that has happened to me and I wish I could have helped these two men see beyond that moment to make another choice.

Submitted by Anonymous on Mon, 07/01/2013 - 3:54pm

Talking about suicide is hard. I think the stigma attached with suicide and mental illness prevents some people from asking for help. When you're depressed, you already feel like no one really cares. I agree with the social disconnection theory. Knowing that there is even one person who will listen (and not freak out) when you talk honestly about your feelings can make all the difference.

Submitted by Anonymous on Mon, 07/01/2013 - 7:48pm

A day does not go by that I do not think of my loving uncle who thought he had no way out rather than to take his own life. A loving father of 2 beautiful babies that would have grown up to love him so much. He always seemed like he was on top of the world and that nothing could stand in his way until he felt like he was going to lose the loves of his life.... One bad night for him left us with an emptiness we will feel forever. I believe that the one single action was too much for him to handle on the last night of his life and it sent him over the edge, His mind on edge and unable to comprehend a way out. I always wonder what if I would have just called him, would he still be here, the what if's ....MY HEART ACHES.